Kaiser, Don't Deny
Patients need access to consistent, reliable mental health services
Patients referred out to providers with no availabilityPublished Thursday, October 14, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a therapist at Beacon, who has seen how badly the demand for mental healthcare far exceeds Kaiser’s ability to provide it.
I am a therapist who contracts with Beacon to provide mental health services to Kaiser patients. My practice has been full for about six months, and I have had to turn down dozens of people desperate for help. I always feel sympathy for people who are in need of help and cannot find it because so many contracted providers are full.
Patient not considered “severe” enough to get treatmentPublished Tuesday, October 12, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a parent who was shuttled between Kaiser and the county system, and still never got help.
I was removed from Kaiser to the county system due to being “too severe” a patient. I requested to go back to Kaiser, as the county system is overworked as well. I made an appointment in December 2018 for a therapy appointment in March 2019. The appointment was canceled the day of and was rescheduled for May 2019. I was told that I was no longer eligible for the higher care they provide to certain patients due to the lack of severity of my symptoms. I no longer tried to make another therapy appointment, as being seen by a therapist four times a year isn’t conducive to the care that I require for my symptoms, but since my symptoms are controlled by medication, I am not considered severe by Kaiser anymore.
Patient seeks therapy, referred to group that isn’t availablePublished Thursday, October 7, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a parent who was told that only group therapy was available for their child — and there was no group currently available for her.
I brought my daughter to see a therapist after she was diagnosed with learning disabilities and an autoimmune disorder. I was shocked when I told by the therapist who conducted the intake: “We don’t provide individual therapy. I can refer your daughter to a group, but we don’t have a group right now with children her age.” I sought individual treatment for her outside of Kaiser and paid out-of-pocket for weekly therapy. I am a clinical psychologist and my newest referral in my private practice is a Kaiser patient who was told she could not receive mental health services because her case was not acute and she was not suicidal.
Care delayed and denied for anorexic teenPublished Tuesday, October 5, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from parents encountering obstacles getting the proper care for their anorexic daughter.
My daughter has anorexia. She has been hospitalized by Kaiser in the past for heart problems due to her eating disorder. She has participated in their Intensive Outpatient Program (not helpful). She relapsed recently. We are asking for out-of-network support. Dr says that what KP has in house is equivalent (its not — by a long shot). Also being told out kid doesn’t have the “unique” issues that would warrant referral. They say the provider we want to see would be great and they have a lot of faith in them, but that OUR daughter doesn’t qualify to see them — but we aren’t told why or according to what criteria. This feels like care delay and denial — for an often fatal illness.
Patients are denied therapy, referred to programs that don’t helpPublished Thursday, September 30, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from parents who have struggled to get help for depressed child:
For five months, our once healthy child without any mental health issues has now been in and out of six mental hospitals, three residential programs, three outpatient programs, three county stays, multiple emergency room visits, and now an ineffective and redundant IOP program. All the while, our kid’s depression is still a daily struggle. When we tell the Kaiser IOP therapist and the facility manager about the struggle and request directly someone to work with our child individually – we are denied, two times. We are being denied intensive one on one therapy and constantly referred to a program that isn’t working.
Rachel and Terry
A 10-week wait for an intake appointmentPublished Tuesday, September 28, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient who has tried to access mental services at Kaiser, with little success, three times in the last four years:
I have a history of severe clinical depression. When I sensed a depressive episode coming on I contacted Kaiser and asked to see a different therapist. That simple request meant I am waiting 10 WEEKS to get a basic intake appointment.
I tried multiple times to call and find a workaround. I filed a grievance and an appeal with Kaiser; both were denied. They claim that they are offering care with a psychiatrist and group therapy (via Zoom.) Any mental health practitioner will tell you that those two things are tools, but not a replacement for 1:1 therapy with a mental health practitioner.
In the end, I am paying out of pocket to ensure I get the care I need in a timely fashion. Ten-week delays are potentially dangerous for someone with depression.
This is the third time in four years that I have been in a situation where Kaiser makes it so difficult to access 1:1 therapy that I have had to go out of network and pay out of pocket. This is not a COVID issue. It’s a Kaiser issue.
NBC7 Investigative Team reports on Kaiser mental healthPublished Tuesday, September 21, 2021 #
In the latest installment of its Breakdown series of mental health care in San Diego, NBC-7 chronicled the story of Emily Pacillo, who was denied mental health care from Kaiser Permanente when she moved to San Diego from Boston.
Despite having been diagnosed with anxiety disorder and receiving weekly therapy from her former insurance company, Pacillo was told by Kaiser she would become eligible for services if she had “a mental crisis.”
“If we are going to compare this to regular medicine, basically I don’t go in for checkups until I have Stage 4 cancer,” Pacillo said.
Jim Clifford, a longtime Kaiser mental health clinician, said that even those patients who get care from Kaiser are routinely forced to wait one-to-two months between appointments. “It’s a very difficult way to operate; it’s not the standard of care by any means in psychiatry.”
Clifford told the station that Kaiser focuses more on figuring out ways to tell people they don’t need treatment or rushing them through, rather than simply fixing staffing shortages.
In June, Clifford and his fellow Kaiser clinicians in San Diego to management stating, “As providers, it is devastating for us to acknowledge that the ethical care and accessibility needed to best serve our patients is not what we are able to provide — far from it.”
In a statement to the station, Kaiser acknowledged that “there is still so much more … to do before we can truly address the growing demands for mental health care.” However, the HMO has so far refused to even consider proposals from its clinicians to boost staffing and improve working conditions so Kaiser can recruit and retain more clinicians.
Dr. Jared Skillings, Chief of Professional Practice for the American Psychological Association, criticized the process Kaiser used in denying therapy sessions to Pacillo and said Kaiser needs to take mental health care more seriously.
“It frankly makes it look like mental health care is the poor step child, which is just entirely inappropriate,” he said.
Pacillo told the station she’s grateful that she was able to leave Kaiser and resume her mental health therapy. “Your health insurance plan is exactly for that — your health,” she said. “And, they don’t care about your health.”
Kaiser clinicians in San Diego sounded alarm about patient accessPublished Monday, September 20, 2021 #
Before NBC7 in San Diego profiled Emily Pacillo’s struggle to access mental health care from Kaiser Permanente, Kaiser clinicians were raising alarm bells to managers that went unheeded.
In June they alerted management that patients were waiting on average six weeks between therapy appointments and then even if they put patients on a waitlist for an earlier appointment, those slots became “instantaneously converted to crisis appointments without consideration of the waitlists of patients already vying for sooner appointments.”
Even therapists designated to see patients with more urgent needs were having their open appointment slots assigned to new patients or patients in crisis, forcing their current patients to wait longer and longer for treatment.
The therapists wrote to management:
Kaiser Permanente’s ongoing media and publicity campaigns highlighting client-centered continuity of care for their members may appear empathic and understanding of their patients’ mental health struggles but the reality is: KP leadership’s actions have proven to be nothing more than a ruse – an evocation of advocacy. The unveiled truth confirms that Kaiser offers only empty promises of care instead of a timely plan of treatment for actual wellness and recovery.
In closing, they called on management to focus on the mental health needs of Kaiser patients, not the operational limitations of the clinics that Kaiser is under-resourcing:
It is our belief as NUHW members who directly treat suffering mental health patients that decisions should not be made with consideration of the clinic, but rather in consideration of the patient. We as NUHW members demand to work within an organization that empowers its managers and staff to make decisions and functions not based on clinic or operational need but rather BASED ON PATIENT NEED.
Patients endure long waits for limited treatment optionsPublished Thursday, September 16, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient who experienced long waits and limited treatment options:
I have had Kaiser on and off for decades. They have THE worst mental healthcare. In addition to delayed care, they have cookie cutter care. An actual flow chart to what they will prescribe and it’s never the most cutting edge; their formulary is the cheapest. All about profit, not care. It takes months to transfer meds. from other insurance provider; often running out having to go to ER to prescribe when desperate. They preferred to prescribe ADD meds off label for treatment-resistant depression, rather than to try a promising newer med. After leaving Kaiser, I was given that new med. and had almost instant improvement.
Struggling families must look outside Kaiser for the help they needPublished Tuesday, September 14, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient who is spending thousands out-of-pocket to get care for her daughter.
My youngest daughter was in the emergency room twice within the last year for serious cutting (she has bi-polar, borderline personality disorder and ADHD), and they discharged her with a note “nothing concerning” on the discharge papers after she had cut her wrist the deadly way. After I filed a complaint, they offered her a DBT class and then cancelled it without telling her. Since then, we have not been able to get her any treatment. Last week, to no one’s surprise, she tried to cut her own throat and ended up in a 72-hour psych hold. They have her in outpatient therapy for suicide prevention, but are not addressing her underlying diagnosis. I pay out of pocket for DBT therapy ($2K/mo) and hired a $600/hour psychiatrist to diagnose her bi-polar and borderline, but it is putting me in the poor house. The only progress made with this last visit is that she now has a KP psychiatrist and is on some new meds for the ADHD. I am traumatized from all of this and hope my girl stays alive.
Oakland and Los Angeles
Kaiser can’t provide care, patients pay more to get it elsewherePublished Thursday, September 9, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient who has to pay more to get the care she needs — because Kaiser can’t provide it.
After struggling for years with body dysmorphia, I reached out to mental health services through Kaiser. It took me two different therapists with month-long waiting periods and multiple cancelled appointments with part-time therapists before I decided to find an out-of-pocket therapist. Now I pay$65 a session instead of $25, but I have consistent appointments every week.
Patients give up on getting timely mental healthcare from KaiserPublished Tuesday, September 7, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient who, like many, has given up on getting timely care from Kaiser.
One time I finally got an appointment at Bostonia. The person I met with asked very basic questions. She typed word-for-word what I said, but I could not tell her any problems. Never went back. I had an appointment at La Mesa, and the woman I talked to again asked very basic questions. She typed everything I said and changed my medication. It took me a long time to get my medication straightened out, and then I never went back. I tried recently to get an appointment and it was so far out I gave up. I am diagnosed with severe depression and told them I was very depressed when I called.
Patients can easily get prescriptions, but not therapyPublished Thursday, September 2, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in the Bay Area who has repeatedly tried to get help from Kaiser.
I think it’s incredibly damaging, when you reach out repeatedly and no one is there to help. It’s difficult when this has been a pattern in your life and it gets repeated in the context of seeking professional help. I tried to make it work. I did the “intake,” which was not a therapy appointment — I was cut off from talking and then I shut down emotionally as a result. At the intake I was told I could book with a former therapist and that’s what I ended up doing. I was going to wait two months for an actual appointment, and then my appointment was cancelled with no notice to me. My medical record states that a voicemail was left on my phone but that’s not true. I only found out my appointment had been cancelled after I logged into my online account. The pandemic has contributed to my feeling socially disconnected. Trying to get help through Kaiser Permanente made that worse, but treating people this way makes sense if you want to discourage them from seeking help.
Mental health clinicians tell Kaiser they don’t have staff to provide clinically-appropriate carePublished Wednesday, September 1, 2021 #
Demand for behavioral health care is surging during COVID-19, and the psychologists, therapists and social workers at Kaiser Permanente are warning that their patients are being forced to wait far longer than is clinically appropriate between therapy appointments.
Since November, the clinicians have been writing letters to management spelling out the challenges they face providing timely, appropriate care to their patients, yet Kaiser has failed to address their concerns as wait times continue to grow. Here is an excerpt from a letter to management written by Kaiser mental health clinicians in the Diablo Service Area outside of San Francisco.
“Given the incredible increase we have seen in both demand for services and severity of symptoms in our patients, as well as the exodus of clinicians who can no longer survive in these working conditions, it is currently not possible for us to provide treatment in line with the Standards of Care of our profession. In our respective clinics in Antioch, Pleasanton, and Walnut Creek, our Generalists see patients for an assessment, and this is currently followed by a five to nine week or longer wait until we can provide an individual return appointment. While group treatment, without concurrent individual treatment, is not an appropriate or acceptable level of care for most patients, we are currently experiencing group sizes that are so large and group waitlists that are so long, that we cannot even offer these group services to our patients…”
In response to this letter and others sent from clinicians in different service areas, Kaiser has sent unsigned response letters that offer clinicians no opportunity to continue the conversation.
Not only did Kaiser’s response fail to address the concerns raised by clinicians, it repeated Kaiser’s distorted claim that more than 90 percent of mental health patients are booked for a new appointment “within the timeframe identified by the treatment plan.”
This ignores the fact that Kaiser officials threatened clinicians to stop a concerted effort last year to document when their patients could not receive appointments within an appropriate time interval. In an email on February 12, 2020, a Kaiser manager in Orange County wrote to clinicians:
“Recently there has been a new position taken or encouraged as to how NUHW clinicians document follow-up care that falls outside of the clinical recommendation, and it’s my understanding that this documentation is being captured in the patient’s medical record.”
The email continued:
“Per KP legal, ‘…our position was (and should remain) that this is inappropriate information for the patient’s chart. We should consistently encourage them to escalate any case in which they are unable to schedule a return appointment within the time they believe the patient needs to be seen, and we should make every effort to get the patient in (unless it’s clear the request is not warranted, in which case we should be very clear about why the request is not warranted).’”
While the manager asked the clinicians to follow up with him about any patients who needed more immediate care, when appointment wait times already far exceed clinically-appropriate standards, it’s impossible for clinicians to expedite care for the vast majority of their patients who need it.
NUHW Kaiser clinicians team up with leading mental health parity attorneyPublished Tuesday, August 31, 2021 #
Kaiser mental health clinicians have a new ally in their fight to improve access to care and working conditions. Meiram Bendat, the nation’s leading attorney specializing in mental health parity law, has been retained by NUHW.
Bendat held an initial meeting this month with Kaiser Permanente clinicians and our research team to help us document access to care issues so that we are better positioned to work with Kaiser to address them.
In 2019, Bendat’s firm, Psych Appeal, won a landmark class-action lawsuit against United Behavioral Health, in which the country’s largest managed behavioral healthcare company was found liable for rejecting the insurance claims of tens of thousands of people seeking mental health and substance use disorder treatment based on incorrectly claiming that the treatments were not medically necessary.
The following year, Bendat helped author SB 855, the landmark mental health parity bill that many NUHW members helped pass into law. SB 855 requires that insurers, including Kaiser:
- Cover all psychiatric illnesses and substance use disorders identified in the most recent version of the APA’s Diagnostic and Statistical Manual.
- Standardize criteria for “medical necessity” to align with the profession’s standards of care, as opposed to the arbitrary standards insurers had previously used.
- Pay for out-of-network care if their internal network can’t meet a patient’s need.
NUHW and Bendat worked hard to pass SB 855, and we have a shared interest in making sure that the law is fully implemented and enforced. During our first meeting with Bendat, a dozen Kaiser therapists discussed several recurring issues at Kaiser clinics, including:
- The difficulty patients face in many service areas finding external providers and the lack of oversight in many service areas in documenting the outcomes of patients who are referred to outside providers.
- The challenge of using Kaiser’s templates to accurately document recommendations for how frequently a patient should be seen and whether patients are being offered treatment that meets the required standard of care.
- The disparity in external provider access for children as compared to adult patients.
- The lack of clear policies and procedures for making appropriate treatment frequency and duration available to a patient once a clinician has determined which psychotherapy interventions are medically necessary.
- The overbooking of therapy groups in certain service areas that are not in compliance with limits set by Medicare.
Bendat is very familiar with our battle for behavioral health parity over the past decade, and he’s as excited to work with NUHW, as we are to work with him.
“What you’re doing is very noble,” Bendat said during the meeting. “I’m really impressed with all the efforts… I love working with groups that are passionate about what they are trying to achieve. It’s really terrific and great to be a part of that.”
Patients can easily get prescriptions, but not therapyPublished Tuesday, August 31, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in Southern California who can easily get medications from Kaiser, but not the therapy she needs.
I’ve been a Kaiser member 2018 and it has been a battle to receive proper mental health care the whole time. It takes weeks to receive an appointment — this was true before COVID and it’s even harder now. When you finally receive one, you’re on a time restraint of one hour, even if the appointment did not begin on time. Once your hour is up, it’s up. They are quick to push the meds but don’t offer proper therapy. When I expressed that I needed more therapy, not meds, I was told that my condition would not improve without medication, and that the reason I felt I needed therapy was because I was not taking the medication. I’ve made several complaints, even physically went into member services office and all they did to help was call into the department and get me an expedited appointment, After that it was the same thing. Nothing has changed.
A two-month wait for helpPublished Thursday, August 26, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in San Rafael who has to go two months between therapy appointments.
I waited eight weeks between psychiatrist visits. All she did was give me medications, all of which made me feel worse. Therapy included video visits in chat rooms with other people. That’s no help at all.
Grieving patients wait months for carePublished Tuesday, August 24, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a grieving patient in Vacaville who has to wait months for therapy.
My husband, my sister, and my son died within three months of each other, but I can only talk to a counselor about every three months. I need more.
Why do we wait for rock bottom?” A mother chronicles her daughter’s struggle with mental illness and their battle to get adequate care from Kaiser PermanentePublished Thursday, August 19, 2021 #
Jasmin Iolani Hakes wrote a chilling commentary in the Los Angeles Times recently about her 20-year-old daughter’s struggle with mental illness and her recent suicide attempt.
Hakes, whose daughter is a Kaiser Permanente member in California, described the agony of not being able to get her daughter the care she needed as she began cutting herself and having panic attacks as she entered puberty.
The cutting worsened. Crippling anxiety and panic attacks that lasted a day or two became the norm. We did what we could with what our healthcare provider offered, but she was stuck in a horrible middle: Not OK enough to be helped much by once-a-week therapy, not an addict fit for rehab. I called every helpline and hotline. Weeks and months and years went by, as we begged for appointments and assessments, and searched for programs that fit.
When Hakes’ daughter was 20 years old, her condition worsened and she entered Kaiser’s intensive outpatient treatment program. When the program was finished, however, Kaiser failed to provide timely and appropriate follow-up care.
We spent weeks pestering our healthcare provider about getting her assigned to doctors and a group. She had her first follow-up therapy session at the end of month two. We’re still waiting for the group therapy to begin.
Her daughter’s condition worsened, culminating in her attempt to end her life. As her daughter struggles to address her mental health condition, Hakes makes a poignant case for better access to care.
Why do we make it so hard to find a place for those who are mid-fall, who need more than once a week with a therapist, less than an intervention on the street? Why do we wait for them to hit rock bottom?
Hakes, who didn’t disclose the name of her daughter’s healthcare provider in her Los Angeles Times commentary, later shared Kaiser’s name with NUHW and gave permission to share it publicly.
Struggling patients wait months for helpPublished Thursday, August 19, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in Northern California who’s waited months to get an appointment, despite severe depression.
It took so long for me to reach out for help because I was ashamed to admit I had bad depression and anxiety. “I work as a nurse, so I should have it together,” was my thinking. Then for days all I could think of was I’d be better off not alive. It was so bad I even drove to the ER. I was told another company would reach out to me to continue care … that was 2 months ago.
Excellent caregivers are spread too thinPublished Tuesday, August 17, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in Otay Mesa who has a great therapist –who she can’t get an appointment with.
I have an excellent psychiatrist but I can’t see her nearly often enough. It takes weeks to set up an appointment. I don’t know what would happen in an actual crisis situation.
Patients wait months for minimal carePublished Thursday, August 12, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in the Sacramento area who waited months to see a therapist, and even then only had limited, short-term access to her therapist’s care.
I joined Kaiser’s mental health services almost two years ago. First it took about 6 months to get a therapist, once I did we only had sessions once every two months. That only lasted less than a year then I got a lame excuse on why I can’t see my therapist anymore.
Patients give up on getting carePublished Tuesday, August 10, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in the San Diego area who gave up on getting mental healthcare from Kaiser.
I tried recently to get an appointment and it was so far out I gave up. I am diagnosed with severe depression and told them I was very depressed when I called.
Patients pay out-of-pocket to get care outside KaiserPublished Thursday, August 5, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in Folsom who has spent more than $40,000 out of her own pocket to access mental health care outside Kaiser.
The executives will not be moved by the truth. They will only change policy if it costs them more in lawsuits than to provide care. I have spent more than $40,000 out of my own pocket to receive reasonable care. Most people don’t have the money to go out of pocket, so Kaiser mental health patients are dying while waiting for help. I would likely be dead too if I didn’t have the financial and emotional support of family. My therapist ended up leaving the office because she would rather do psych calls in an ER than not be able to provide the care her patients needed.
Patients are forced to advocate for themselvesPublished Tuesday, August 3, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in San Francisco who has been trying to access therapy at Kaiser for almost a year.
It has been more than eleven months now since I expressed that I need to see a different therapist, and I am still without mental healthcare. I have been shunted off to two other mental health providers who have given me the runaround for months. Every time I contact Kaiser about my frustrations I am met with wonderful but equally frustrated people trying their best to work with a useless system. I am working with a wonderful Kaiser psychiatrist for medications but pills alone are not helping. I’m working on getting into group therapy for some of my concerns, but they are not remotely comprehensive. Advocating for myself while managing my issues alone and working full time is extremely exhausting and I’m at my wits’ end.
Kaiser member forced to pay $1,500 out of pocket per month to get appropriate mental health carePublished Friday, July 30, 2021 #
Victor Gomez was happy with the care he got from Kaiser Permanente, until he sought treatment for anxiety, depression, and post traumatic stress disorder. As he told Capital & Main, Kaiser made his condition far worse by forcing him into group therapy when he needed one-on-one therapy.
“The mental health care is sorely lacking,” Gomez told the news outlet. “It’s based on numbers. It doesn’t even take into account if you did anything about it, just that you talked about it.”
The Capital & Main story illustrates how Kaiser’s broken mental health care system can ruin lives and why Kaiser mental health clinicians are fighting hard to pass legislation and win a contract that will require Kaiser to adequately staff its mental health clinics and provide timely care.
After failing to get the care he needed from Kaiser, Gomez suffered an anxiety attack that resulted in an arrest and a court order that he get treatment for his mental health conditions. But, once again, Kaiser pushed him into group therapy, and Gomez’s conditions actually worsened.
When Gomez’s wife, Karol Jones, came home to find him “in the throes of another panic attack, so frustrated that all he could do was slam his head against their bedroom dresser,” the couple decided to seek care outside of Kaiser.
Despite paying for Kaiser insurance, the couple now is paying $1,500 for the mental health therapy that Gomez needs, but that Kaiser refused to provide.
Here’s what Gomez’s wife, Karol Jones, said in the story about Kaiser:
I really think that Kaiser delaying his treatment spiraled him into a worse situation. That was a missed opportunity for them that really spiraled him into further negative feelings about himself…They’re so good at making sure you get all your preventative medical stuff. I just got another message this morning that I need to go get my mammogram done. They’re great about it, she said. Why can’t they be great at mental health?
Patients who need regular therapy are steered toward group classes that don’t helpPublished Thursday, July 29, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in Stockton with severe depression and anxiety who couldn’t get a timely appointment for the mental health care she needed.
I had an intake telephone appointment with a LCSW yesterday and after having been diagnosed with severe depression and anxiety/panic disorder. I was told that there were no appointments available through November and that there could not be an appointment made for me at this time. I was then offered a group class on “coping skills” in mid-September. Essentially, I have been denied care.
Mental Health Parity Bill advances in California AssemblyPublished Monday, July 26, 2021 #
A landmark bill that would require Kaiser Permanente and all other health plans and insurers in California to offer timely follow-up appointments for mental health and substance use disorders is one step closer to becoming law.
Following a hearing earlier this month, the State Assembly’s Health Committee unanimously passed SB 221 by a vote of 14-0 despite strong opposition from the healthcare industry.
SB 221 would close a loophole that requires HMOs and insurers to offer patients initial mental health and substance use disorder appointments within 10 days, but allows them to make patients wait weeks or months for follow-up appointments. The bill, authored by State Sen. Scott Wiener, would require HMOs and insurers to offer patients follow-up appointments within 10 business days, unless the treating clinicians certify that a longer gap will not harm the patients’ health.
During the committee hearing, lawmakers rejected the claim from health insurance industry lobbyists that it was impossible to provide timely access to follow-up mental health care therapy appointments for lack of qualified professionals in the workforce.
“There is a workforce out there,” said Assemblymember Jim Wood, the committee chair. “I can’t think of anything more discouraging than to get that [initial] timely access in 10 days and then be told you have to wait 6 to 8 weeks for the next appointment.”
Assemblymember Cecilia Aguiar-Curry said: “We have had numerous of our friends pass away from depression and suicide and if they could have had the help sooner I think they would still be here today.”
Kaiser patients as well as clinicians represented by the National Union of Healthcare Workers have been meeting with legislators to advocate for the bill.
Chelsie Martinez, a former Kaiser patient, testified at the most recent hearing how her serious mental health conditions only improved once she began paying out of pocket for weekly therapy outside Kaiser.
“Even knowing that I have access to care when I need it makes me capable of dealing with problems that I otherwise could not,” Martinez testified.
The bill next heads to a vote of the Assembly’s Appropriations Committee before it can go to a vote of the full Assembly and then to Gov. Newsom.
Patients are leaving Kaiser to get mental health carePublished Friday, July 23, 2021 #
More than 1,400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a patient in South Sacramento who had to leave Kaiser to get the mental health care she needed..
I was dealing with a severe crisis and needed to see a counselor badly. When I tried to make an appointment, I had to wait for weeks! It was so frustrating, I couldn’t my get the help I so badly needed at the time. Thank God I had a friend whose husband was a licensed counselor, and I was able to go to him. otherwise I don’t know what I would have done. I finally left Kaiser because of the lack of mental health care there.
Kaiser Permanente criticized for denying patients with postpartum depression the only FDA-authorized drugPublished Friday, July 16, 2021 #
Last year, Governor Gavin Newsom signed SB 855, a landmark mental health parity law written to prevent health plans from denying people mental health care on the grounds that the treatment was not “medically necessary.”
Now it appears that Kaiser Permanente might already be violating the law. In a story aired by KQED, the Bay Area’s home for National Public Radio, Kaiser is accused by patients of denying them the only drug for postpartum depression authorized by the FDA.
“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” said State Senator Scott Wiener, D-San Francisco, who authored SB 855.
One Kaiser patient told KQED that her Kaiser doctor said she would have “to try and fail four medications and electroconvulsive therapy before she could try brexanolone,” the lone antidepressant that has been approved for postpartum women. And she had to try all those other treatments within six months of having her baby or she couldn’t try brexanolone at all.
“That’s absurd,” Dr. Riah Patterson told KQED. Dr. Patterson has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in summer 2019, and she was one of several experts in postpartum depression who told KQED that Kaiser’s guidance “ridiculous,” “harsh,” “abusive” and “insane.”
Making it hard for women to get brexanolone appears to be good for Kaiser’s bottom line.
“Brexanolone treatment costs $34,000 for the medication, plus the cost of the three-day hospital stay, which can tack on another $30,000, at least, according to the report. Kaiser is not yet certified to administer the treatment in-house, so it must pay outside hospitals to provide it.”
But the drug can have a huge impact on the women who are able to take it. Yesenia Muñoz successfully appealed Kaiser’s denial to state authorities, who overturned the decision, according to the report. Munoz went to UC Davis Medical Center to get her first dose and immediately felt better.
“It was like a switch flicked and it made me happy enough to want to live,” she told KQED. “It saved my life.”
Kaiser’s guidance is an outlier, KQED found from analyzing guidelines from a dozen other health plans operating in California.
“Three of them require women to fail one medication before trying brexanolone. One plan — the state’s Medi-Cal program for low-income women — requires two fails. But Kaiser is the only system KQED found that recommends women first fail four drugs,” according to the story.
Family can’t get timely care from Kaiser for autistic sonPublished Wednesday, July 14, 2021 #
More than 1400 Kaiser mental health patients have shared stories at kaiserdontdeny.org of care delayed or denied, and the stories keep coming in. Here’s a recent story from a family in Sacramento struggling to get care for their autistic son.
We have belonged to Kaiser for well over 25 years. Their services for physical healthcare are exceptionally good. However, their services for mental health care are abysmal. We have a 23-year-old son with autism. Since he was three years old we have attempted to get services through Kaiser‘s mental health department. It wasn’t until we went outside of Kaiser that we could actually get his autism diagnosis. We try to secure him regular therapy appointments with Kaiser, but they could only provide appointments once every 4 to 6 weeks — hardly enough for a child suffering from depression and anxiety.
Lawsuit accuses Kaiser Permanente of overstating number of mental health providers available to patientsPublished Monday, June 14, 2021 #
After being fined and repeatedly cited by California state regulators for denying patients timely mental health care appointments, Kaiser Permanente has touted a growing network of mental health clinicians, including non-Kaiser therapists, who could treat patients who would otherwise have to wait weeks or months between therapy appointments.
However, a lawsuit filed last month by San Diego City Attorney Mara Elliott accuses Kaiser of intentionally and illegally overstating the number of mental health providers available to its 9 million members in California.
According to the complaint, 38 percent of the psychologists, therapists and licensed clinical social workers listed in Kaiser’s provider directories were not actually available to care for Kaiser patients.
“Kaiser has been widely criticized in California for its failure to provide adequate and timely mental health services,” Elliott wrote in the complaint. “But rather than actually fixing that problem, it has instead published illusory provider directories to dupe consumers into thinking that its problem with providing mental health care services is resolved, and it has a much larger network than it actually has. In reality, Kaiser’s directories are false and misleading and misrepresent to consumers that they have access to providers that are not actually available in-plan. Kaiser’s failure to provide an accurate provider network is unlawful under state and federal law and has harmed, and is continuing to harm, consumers in San Diego and throughout the State of California.”
Elliott reviewed state data submitted by Kaiser to California’s Department of Managed Health Care. She found that half of the 300 non-physician mental health providers that Kaiser surveyed and deemed ineligible in its 2018 submission to state regulators, half of them remained ineligible the following year.
“The conclusion is inescapable,” Elliott wrote in the complaint. “Kaiser persists in publishing and advertising provider information that Kaiser knows to be false or misleading.”
Insurance companies like Kaiser have a financial incentive to make their provider networks appear larger than they are, Keith Humphreys, a Stanford psychiatry professor, told National Public Radio in a 2016 story about “ghost networks.”
“It’s a way to control cost,” said Humphreys, who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. “You know the law doesn’t say you can’t put people on there who are dead, or you can’t put people on there who are not taking new patients. What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”
Elliott said that Kaiser’s model for delivering mental health care made the “ghost networks” of providers even more problematic for its members.
“Kaiser is particularly reliant on contracted mental health providers, which it uses to compensate for its ongoing mental health care practitioner shortage,” she wrote. “Although Kaiser has sought to alleviate this shortage by providing its patients access to outside providers, this access is often illusory because of the shocking inaccuracy of its directory listings for these outside mental health practitioners.”
In the complaint, Elliott is seeking restitution for Kaiser members who have not received the care for which they paid through their annual premiums, civil penalties against Kaiser, and an order that Kaiser “cease the misrepresentations made to consumers.”
Kaiser has not yet responded formally to the complaint. The case is scheduled for a procedural hearing November 5.